Cooperation within Healthcare Institutions in an Activity-based Payment model Can Technostructure Help Set up Cooperation within Healthcare Institutions? A Case Study

Abstract

Along with the implementation of an activity-based payment model, French hospitals have been undergoing important managerial reforms. These reforms are pushing towards a stronger divisionalization of healthcare institutions (PouvouRvILLE, 2003).As a result, in 2005, the Institut Sainte Catherine (ISC), a non-profit clinic specialized in medical treatment of cancer, chose to restructure itself into two departments: Medical oncology and Radiotherapy. Contrary to the sought effect, this divisionalization reinforced the problems of cooperation within the organization, such as those identified by GLouBERMAn and MInTZBERG in 1996: it led to a detrimental competition between the departments,strengthening the vertical barriers to coordination between specialties, and deepening the horizontal cleavage between the strategic apex and the operating core. To get out of this managerial deadlock, the ISC went through a process of organizational redefinition, starting with the search for a shared vision of collective action based on clinical pathways in cancer treatment. This approach, which has forged the 2013-2018 Strategic Program of the institution, tends to confirm the five guiding principles expounded by MInTZBERG and GLouBERMAn in 1997, aiming at enhancing cooperation in healthcare institutions:social ownership, appropriate scale, involved leadership, collaborative networks, and shared beliefs. It also highlights the role that an independent technostructure (uniting Management Control and Medical Information departments) can play as a link between strategic and operating levels. This form of management control (BouQuIn, 1986), metabolized by Professional Bureaucracy, can contribute to a collaborative style of management of the institution, and help it adapt to external change.